IT'S 7.30 A.M. and your seven year old is writhing on the bed in simulated agony. "The pain feels like a dagger in my tummy," she wails, as you calmly (ha!) insist that, all the same, she must go to school. Today, it's easy to make the judgment call: experience has taught you that any child putting this much energy into simulating sickness is probably pretty well. But judging when your child is sick - sick enough to call the doctor, sick enough to justify the cost, sick enough to keep them home from school, sick enough for you to take time off work to nurse them - is one of parents' most difficult decisions. And although it definitely gets easier after babyhood, it's a problem that never goes away.
Indeed, children getting sick is the nightmare scenario for families where both parents work outside the home. So is there a right way to make that decision about your child's sickness?
The simple answer is, no. There are obvious symptoms - a raised temperature that won't respond to treatment, persistent vomiting over a 24 hour period, being "off their food" - that make it essential to go to the doctor. But what about the coughs, the sniffles, the headaches, the tummy pains, the mystery aches, the fit of miseries?
With babies and small children, it can be as difficult as it is essential to get it right - but at least you know they can't cry wolf. With older children, there can be the added factor of exaggeration, or downright faking, usually arising from our old friend, school phobia.
It is comforting to know that even medical professionals can get it wrong. Mary, a Dublin GP and mother of two, confesses that she, like many of us, has packed a child off to school only to be called later in the morning and asked to bring the sick child home.
"When you're self employed, you have to battle on even when you're ill, and, perhaps unfairly, you expect your children to do so too. I think doctors have less time for sickness at home, because we see it all the time at work."
Like many other medics, she urges parents to trust their own instincts - and learn how to use a thermometer. "If you can see from the end of the bed that they're sick, they're probably sick. Doctors have to make diagnoses on this basis too." In other words, if a child really seems ill, is sloping around, lacking in energy, don't assume they are malingering.
If both of you are working outside the home, it can be agonising to make a decision about a child's sickness, as you both weigh the pressures and deadlines at work against your child's health - and yes, argue as to who must go to work the most.
But there's little evidence that working parents neglect the sick child - indeed, sometimes the opposite is true. "Sometimes they will call the doctor sooner, because they want an instant cure," says Mary.
And Anne Healy, who runs the Sharavogue school and creche in Glenageary, Co Dublin, says that she has never had any trouble with parents sending sick babies to her. "We ask them to respect the rights of other children, and they do: usually, a mother will take off one day, a father another, or they'll have a granny or an auntie who can help."
Catherine, a mother of five who has been an infant teacher for 25 years, says that it certainly does happen that children come to school who should not be in school, for example, children with raised temperatures - but then, she has misjudged her own children's illness too. "It's especially hard to tell about tummy pains."
But although more and more mothers are going out to work, she reckons the incidence of sick children being sent to school is probably falling. Parents generally are better educated about child health and in light of the meningitis scare, they are very watchful. I find most parents are very practical, and will say to me "she's got a pain, please ring me if it gets worse". And like all the saintly infant teachers in the country, she does not get exasperated even when the tummy bug turns into vomiting on the classroom floor.
But she does emphasise the absolute importance of giving your school telephone numbers through which you can be reached, either at your office, your childminder, relative, or neighbour.
As for school phobia, child psychiatrist Dr Michael Fitzgerald says that you will soon get to know the signs - but the first time the physical symptoms appear, you should check them out with your GP, not jump to the conclusion that they're psychological.
The problem of course is that school phobia can cause stress, symptoms like abdominal pains and headache. The difference is, that, they will usually start at 8 a.m. and disappear by 9 a.m. when the decision not to send the child to school has been taken. School phobia can be caused by a lot of factors, some passing, some more long term and serious - but that's another story.
The point is, Dr Fitzgerald says, that if you believe your child is physically ill, you must trust your own gut instincts and check it out. "I take the concerned mother seriously; too often, mothers have been told there's nothing to worry about when it turns out there is."
AND WHILE it is nice, but not essential, for you to nurse your child back to health yourself - it's evident that babies and young children like to sit down on their mammies when they're sick - it's also important to get them mobilised when they're better. "You shouldn't foster sickness by being over solicitous, you should treat them as normal," says Dr Fitzgerald.
Most of us try to be sensible, but we can get it wrong. One mother tells of how she ignored her teenage daughter's appendicitis, thinking she had period cramps (though luckily, not for long enough to be dangerous). Another remembers how her 10 year old's untreated bronchitis resulted in mild pneumonia.
The truth is, judging just how sick a child is a grey area, no matter how well armed we are with Spocks and Stoppards. But advice distilled from parents and doctors suggests that all parents should learn how to use, and read, an old fashioned glass thermometer, to get a really reliable guide to their child's temperature.
And my own life experience tells me that as far as small babies and children go, when in doubt - panic, and get medical advice.
